Cost Effectiveness of Interventions to Reduce Morbidity from Opioid Dependency

降低阿片类药物依赖发病率的干预措施的成本效益

• 批准号: 10186543
• 负责人: DOUGLAS K OWENS
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186543
• 关键词: Address; Adverse event; Affect; Attention; Behavioral; Blood; Blood Tests; Cessation of life; Collaborations; Complex; Cost Analysis; Cost Effectiveness Analysis; Cost of Illness; Dependence; Effectiveness; Effectiveness of Interventions; Epidemic; Equipment; Evaluation; Expenditure; Face; Guidelines; HIV; HIV Infections; HIV/HCV; Health; Health Benefit; Healthcare Systems; Hepatitis C virus; Heroin; Individual; Injecting drug user; Injections; International; Intervention; Intervention Studies; Investments; Life; Literature; Methods; Modeling; Morbidity - disease rate; Naloxone; Needles; Opiate Addiction; Opioid Antagonist; Opioid agonist; Organ failure; Outcome; Overdose; Pharmaceutical Preparations; Policy Maker; Population Characteristics; Public Health; Quality of life; Quality-Adjusted Life Years; Research; Research Design; Resources; Review Literature; Social Work; Substance Use Disorder; Techniques; Time; Veterans; Work; base; budget impact; comorbidity; comparative cost effectiveness; comparison intervention; cost; cost effective; cost effectiveness; cost estimate; cost-effectiveness evaluation; data warehouse; economic outcome; effectiveness evaluation; health economics; improved; incremental cost-effectiveness; injection drug use; innovation; insight; intervention cost; intervention effect; intervention program; military veteran; mortality; opioid agonist therapy; opioid injection; opioid mortality; opioid use; opioid use disorder; pre-exposure prophylaxis; prevent; program costs; programs; psychosocial; scale up; screening; substance use treatment; systematic review; therapy design

Project Background: Over the past decade, opioid use and injection drug use, particularly heroin injection, have increased across most US demographic groups, making opioid-use-related mortality and morbidity a public health crisis both for Veterans and non-Veterans. Morbidity from opioid use is broad, including acquisition of HIV and HCV, which spread efficiently through the transfer of blood in shared injecting equipment. Interventions to prevent morbidity from opioid use disorder include opioid agonist therapy, psychosocial interventions, HIV pre-exposure prophylaxis, clean needle programs, and enhanced testing for blood-borne diseases, but the cost effectiveness of these interventions in VA has not been determined. In prior work, we have evaluated the cost effectiveness of interventions to prevent HIV for people who inject drugs in non-Veteran populations and found some to be very expensive. Project Objectives: This study will assess health outcomes, costs, cost effectiveness, and budget impact of interventions to reduce the morbidity and mortality associated with opioid use disorder. The analysis will assess the cost effectiveness of interventions used individually or in combination when applied to populations of Veterans. Project Methods: To accomplish our objectives we will develop cost effectiveness models that assess health outcomes, cost, cost effectiveness, and budget impact of interventions to reduce morbidity and mortality from opioid use disorders. We will extend models that we have developed previously to reflect the costs and population characteristics of Veterans. Our analyses will include opioid agonist therapy, psychosocial interventions, HIV pre-exposure prophylaxis, use of naloxone, intensive screening for HIV and HCV, and other opioid use disorder treatments. To develop parameter estimates of effectiveness and harms of interventions, we will systematically review studies of interventions and assess study design, study quality, consistency, and applicability to Veteran populations. We will also assess whether comorbid conditions and receipt of social services affects the effectiveness of opioid use disorder treatment. To estimate costs of interventions we will use both literature-based estimates for interventions that VA has not provided and VA costs where available and appropriate. Our analyses will estimate both cost effectiveness and budget impact. Cost effectiveness is determined by the incremental benefit of an intervention compared to the next best alternative intervention divided by the incremental costs. Single interventions are unlikely to provide the same degree of benefit as combined interventions. However, how cost effectiveness varies for multiple interventions requires careful analyses because interventions may be synergistic or duplicative. Our analyses will account for these interdependencies. Our analyses will estimate deaths averted, adverse events from treatment, life years gained, quality-adjusted life years gained, cases of HIV or HCV averted (where appropriate), costs, and incremental cost effectiveness. Cost effectiveness provides insight into value and efficiency. However, even programs that are cost effective may require large total investments. Therefore, we will also estimate the budget impact of programs singly or in a portfolio. Budget impact captures the total expenditures that are required for implementation of programs at various levels of coverage or scale up. The study will provide an understanding of which interventions or combinations of interventions are likely to most improve the health of Veterans with opioid use disorder, along with estimates of the efficiency and total costs of the programs.

项目背景：在过去的十年中，阿片类药物使用和注射药物使用，尤其是海洛因注射， 在大多数美国人口组中，已经增加了与阿片类药物相关的死亡率和发病率 退伍军人和非退伍军人的公共卫生危机。阿片类药物使用的发病率很广，包括 收购艾滋病毒和HCV，它们通过共享注射中的血液转移有效传播 设备。防止阿片类药物使用障碍发病率的干预措施包括阿片类药物疗法， 社会心理干预措施，艾滋病毒预防前预防，清洁针程序和增强的测试 血源性疾病，但尚未确定这些干预措施的成本效益。在先验 工作，我们已经评估了干预措施的成本效益，以防止注射毒品的人的艾滋病毒 非退伍军人人口，发现有些人非常昂贵。 项目目标：本研究将评估健康成果，成本，成本效益和预算的影响 减少与阿片类药物使用障碍相关的发病率和死亡率的干预措施。分析将 评估单独或组合使用的干预措施的成本效益 退伍军人。 项目方法：为了实现我们的目标，我们将开发成本效益模型来评估健康 干预措施的结果，成本，成本效益和预算影响，以降低发病率和死亡率 阿片类药物使用障碍。我们将扩展我们以前开发过的模型，以反映成本和 退伍军人的人口特征。我们的分析将包括阿片类药物激动剂疗法，社会心理 干预措施，HIV预防前预防，纳洛酮的使用，HIV和HCV的密集筛查以及其他 阿片类药物使用障碍治疗。为了开发有效性和干预损害的参数估计， 我们将系统地审查干预措施的研究并评估研究设计，研究质量，一致性和 对退伍军人的适用性。我们还将评估合并的条件和社会的接收 服务影响阿片类药物使用障碍治疗的有效性。为了估计干预成本，我们将 使用两种基于文献的估计值，用于VA尚未提供的干预措施和可用的VA成本 适当。 我们的分析将估计成本效益和预算影响。成本效益取决于 与下一个最佳替代干预措施相比，干预的增量益处除非 增量成本。单一干预措施不太可能提供与联合合并的相同程度的收益 干预措施。但是，多种干预措施的成本效益如何变化，需要仔细分析 因为干预措施可能是协同作用或重复性的。我们的分析将考虑到这些 相互依存。我们的分析将估计避免死亡，治疗，生命年的不良事件 获得，质量调整的终身年份，避免了艾滋病毒或HCV病例（适当的情况下），成本和 增量成本效益。成本有效性提供了对价值和效率的见识。但是，甚至 具有成本效益的计划可能需要大量投资。因此，我们还将估计 计划单独或投资组合的预算影响。预算影响捕获了总支出 在各个级别的覆盖范围或扩大规模上实施计划所需的要求。该研究将提供 了解哪种干预措施或干预措施的组合可能会大多改善 阿片类药物使用障碍的退伍军人，以及计划的效率和总成本的估计。